Prolog Flashcards
1
Q
Possible cancers in Lynch II aka hereditary nonpolyposis colorectal cancer
A
Endometrium
Ovary
Gastric tract
Small bowel
2
Q
Mismatch repair genes affected in lynch II aka HNPCC
A
MLH1 MSH2 MSH6 PMS2 EPCAM
3
Q
Lynch syndrome-associated endometrial cancer accounts for up to X% of all endometrial cancer
A
6%
4
Q
germline TP53 mutations are associated with __ syndrome
A
Li–Fraumeni
5
Q
Li-Fraumeni syndrome is associated with a high risk of what 5 kinds of cancer?
A
soft tissue sarcomas leukemia adrenocortical cancer breast cancer brain cancer
6
Q
Overexpression of PTEN is associated with __
A
Cowden disease
7
Q
Heritability of Cowden disease
A
autosomal dominant
8
Q
Cowden disease is associated with what 3 cancers & what skin lesion?
A
breast cancer
thyroid cancer
endometrial cancer
benign mucocutaneous lesions
9
Q
A 45-year-old woman is diagnosed with grade 2 endometrioid adenocarcinoma of the endometrium, and she undergoes hysterectomy, BSO, and LA. She has a family Hx that includes cancer of the breast, lung, and colon in first-degree relatives. The test that will best inform her of her risk of future cancer is immunohistochemical staining of tumor tissue for: (A) MLH1, MSH2 overexpression (B) BRCA1 mutation (C) progesterone receptor (D) TP53 mutation (E) PTEN mutation
A
(A) MLH1, MSH2 overexpression
10
Q
lifetime risk of breast cancer for a woman who carries a BRCA1 or BRCA2 mutation
A
65–74%
11
Q
lifetime risk of ovarian cancer for a woman with a BRCA1 mutation
A
39 – 46%
12
Q
lifetime risk of ovarian cancer for a woman with a BRCA2 mutation
A
12 - 20%
13
Q
Risk of what other malignancies in BRCA2?
A
prostate
pancreatic
melanoma
14
Q
In BRCA, risk-reducing salpingo-oophorectomy decreases the risk of breast cancer by:
A
50%
15
Q
In BRCA, Risk- reducing salpingo-oophorectomy decreases the risk of ovarian cancer by:
A
80 – 95%
16
Q
For ovarian cancer in BRCA pts, Risk reduction after 5 years of use: X%
A
33% to 38%
17
Q
A 42-year-old woman, G2P2, in whom breast cancer was diagnosed at age 38 years, comes to your office for her annual well-woman visit. Her family history is significant for a mother who was diagnosed with ovarian cancer at age 68 years and a maternal aunt who developed a low- malignant-potential tumor of the ovary in her 20s. Her risk of having an inherited predisposition for ovarian cancer or breast cancer is: (A) less than 1% (B) 1–10% (C) 11–20% (D) greater than 20%
A
(D) greater than 20%
18
Q
A 45-year-old woman, para 2, has been hospitalized with symptoms of diplopia, vertigo, and dizziness for the past 10 days. Three days ago, she had a contrast MRI scan of the head, which was negative for mass effect, lesions, and plaques. She has an elevated platelet count of 800,000/mm3. A body CT is negative except for a 6-cm complex lesion in the left ovary. Mammography was negative 1 month ago. On physical exam, you confirm the neurologic deficits. Analysis of serum and CSF samples show elevated anti-Yo antibody levels. The best explanation for these findings is: (A) hemorrhagic stroke (B) embolic stroke (C) paraneoplastic syndrome (D) multiple sclerosis
A
(C) paraneoplastic syndrome
19
Q
Anti-Y o progressive cerebellar degeneration most commonly is associated with:
A
ovarian or breast carcinoma
20
Q
Elevated platelet count is often another paraneoplastic manifestation of ovarian cancer resulting from:
A
increased production of thrombopoietic cytokines in the tumor and host tissue
21
Q
A 42 yo Asian woman w/ a history of molar pregnancy comes to your office 13 months after initial diagnosis. Her serum β-hCG level is 14,650 IU/L. You diagnose gestational trophoblastic neoplasia (GTN). Her exam shows a 1-cm vaginal lesion. Pelvic US shows a 4-cm intrauterine tumor. Chest, abdomen, and pelvic computed CT scans show a 2-cm lung lesion consistent with metastatic disease. Head MRI is negative for metastasis. Her age, β-hCG level, 4-cm intrauterine tumor, and total of 2 metastatic sites give her a modified WHO risk score of 5. The factor that increases her WHO score to 9 is:
(A) previous molar pregnancy
(B) interval from molar pregnancy to GTN diagnosis longer than 12 months
(C) vaginal metastasis on exam
(D) lung metastasis
A
(B) interval from molar pregnancy to GTN diagnosis
22
Q
Treatment for GTN: stage I disease and low-risk (score less than 7) stage II and III disease
A
single-agent chemotherapy with either methotrexate or actinomycin D
23
Q
Treatment for high-risk GTN disease: either stage IV disease or high-risk (score 7 or more) stage II and III disease,
A
multiagent chemo with or without site- directed surgery or radiotherapy
(1) Etoposide + methotrexate + actinomycin D + cyclophosphamide + vincristine (2) methotrexate + actinomycin D + cyclophosphamide
24
Q
cyclophosphamide MOA
A
alkylating agent – prevents cell division by cross-linking DNA strands and decreasing DNA synthesis
25
cyclophosphamide adverse effect
hemorrhagic cystitis
26
bleomycin MOA
inhibits synthesis of DNA; binds to DNA leading to single and double strand breaks
27
bleomycin adverse effect
pulmonary fibrosis
28
doxorubicin MOA
inhibits topoisomerase II -- inhibition of DNA and RNA synthesis, inhibition of DNA repair
29
doxorubicin adverse effect
cardiotoxicity
30
vincristine MOA
inhibits microtubule assembly - arrests cell at metaphase by disrupting formation of mitotic spindle (M & S phases)
31
vicristine adverse effect
neurotoxicity
32
carboplatinum MOA
alkylating agent - covalently binds to DNA, interstrand DNA cross-links; not cell-cycle specific
33
carboplatinum adverse reaction
thrombocytopenia
34
cisplatinum (cisplatin) MOA
inhibits DNA synthesis by formation of DNA cross-links, denatures double helix, covalently binds DNA
35
cisplatin adverse reaction
nephrotoxicity, neurotoxicity, ototoxicity, emetogenic
36
paclitaxel (Taxol) MOA
inhibits microtubule disassembly, interfering with late G2 mitotic phase
37
paclitaxel (Taxol) adverse reaction
Alopecia, immediate hypersensitivity, neutropenia, bradycardia
38
methotrexate MOA
folate antimetabolite that inhibits DNA synthesis, repair, and cellular replication - inhibits dihydrofolate reductase - cell cycle specific for S phase
39
methotrexate adverse reaction
Neutropenia, mucositis, nephrotoxicity
40
5 fluorouracil MOA
pyrimidine analog antimetabolite that interferes with DNA and RNA synthesis - inhibits thymidylate synthetase
41
5 fluorouracil adverse reaction
Neutropenia, mucositis, diarrhea, dermatitis
42
topotecan
inhibits topoisomerase I - stabilizes the cleavable complex so that religation of cleaved DNA strand cannot occur - S phase of cell cycle
43
topotecan adverse reaction
profound neutopenia
44
cycle nonspecific alkylating agents
cyclophosphamide
chlorambucil
platinum compounds
45
2 plant alkaloids
vincristine
| vinblastine
46
plant alkaloids are __ phase specific
M phase
47
methotrexate is __ phase specific
S phase
48
chemo drug from the pacific Yew tree
Taxol
49
Taxol is __ phase speicific
M phase
50
antidose to ifosfamide
mesna
51
BRCA1 on chromosome __
17
52
BRCA2 on chromosome __
13
53
heritability of BRCA mutations
autosomal dominant
54
p53 & Rb are examples of __ genes
tumor suppressor
55
ras, HER-2/neu are examples are __ genes
oncogenes
56
What is the most common tumor in the broad ligament?
leiomyoma
57
metastatic tumore from stomach to ovary
Krukenburg tumors
58
cells found in Krukenburg tumors
signet ring cells
59
dermoid with mostly thyroid tissue, benign
struma ovarii
60
hydrops tubae profluens is a classic sign of :
fallopian tube carcinoma
61
optimal treatment of dermoid cyst
cystectomy with only inspection of contralateral ovary
62
treatment for endometrial hyperplasia
TAH vs progestin therapy (any progestin will do); premalignant potential directly related to degree of cellular atypia and to a far less extent the degree of architectural complexity; microscopically has crowded glands but no invasion
63
the action of lasers is based on __
Water (cells heat and explode)
64
most common tumor to metastasize to fetus
melanoma
65
What is luteoma of pregnancy
solid, benign tumor requiring no treatment; regresses after pregnancy
66
What is Meig's syndrome
triad of ovarian fibroma, hydrothorax, ascites
67
most common sites of ureteral injury
at cardinal ligaments and infundibulopelvic ligaments
68
lymphatic drainage of vulva
inguinal
69
lymphatic drainage of lower part of vagina
inguinal
70
lymphatic drainage of upper vagina
iliac (pelvic)
71
lymphatic drainage of cervix
iliac (pelvic)
72
lymphatic drainage of uterus
iliac and paraaortic
73
acetic acid MOA
dehydrate cells
74
Lugol's iodine MOA
glycogen stain; negative stain
75
after transection the broad ligament, the ureter is where?
on medial leaf
76
When doing omentectomy must ligate the __ arteries
gastroepiploic arteries
77
What are the steps of the cell cycle?
G1 - S (DNA replication) - G2 - M (mitosis)
78
attributes of plain and chromic catgut
intense inflammation, absorbed quickly by phagocytosis
79
attributes of Vicryl and Dexon
polyfilament, absorbed by hydrolysis
80
attributes of PDS & Maxon
monofilament, highest tensile strength for absorbables
81
attributes of Nylon & Prolene
monofilament, highest tensile strength of all sutures, nonabsorbable
82
cause of dyspereunia after radiation is usually:
atrophic vaginitis
83
Most important prognostic factor for endometrial, cervical, vulvar and breast cancer is:
node status
84
Main difference between tamoxifen and raloxifene is:
effect on endometrium (tamoxifen is proliferative)
85
Most likely histologies of vulvar cancer
1. Squamous cell cancer most common (~85% of all vulvar cancers)
2. melanoma (~9%)
3. Basal Cell Carcinoma (2%)
4. Paget’s disease, Bartholin’s adenocarcinoma, sarcomas, and neuroendocrine tumors all rare
86
Are chorionic villi found in molar pregnancy?
No
87
Tx for stage IB1 cervical cancer, lesion 2cm or less, in patient desiring fertility
radical trachelectomy with pelvic lymphadenectomy
| abdominal cerclage
88
genetic inheritance of Lynch
autosomal dominant
89
When should screening start in Lynch
age 25-30 years, or 10 years before known familial cancer
90
What should screening consist of for Lynch?
q1-2 year colonoscopy, endoscopy
?annually TVUS and endometrial biopsy
Ca125 annually age 30-35
consider risk reducing surgery
91
What 3 elements in a molar pregnancy make GTN 40% likely?
beta HCG >100,000
uterine size greater than dates
theca lutein cyst >6cm
92
Schiller Duval bodies on histology
endodermal sinus tumor
93
endodermal sinus tumor secretes __
AFP
94
Women with a 5 year predicted risk of > __% for breast cancer are candidate for tamoxifen chemoprevention
1.66%
95
tamoxifen demonstrated a __% decreased risk reduction in breast cancer in high risk premenopausal and menopausal women
49%
96
side effects of tamoxifen
leg cramping, vasomotor symptoms
97
treatment for late onset multidrug resistant pneumonia
antipseudomonal fluoroquinolone
beta lactam inhibitor
anti-MRSA
98
greatest risk factor for development of ovarian cancer in patient without family history
nulliparity
99
BRCA1 ovarian cancer risk
39-46%
100
BRCA2 ovarian cancer risk
12-20%
101
80% of mucinous tumors are __, characterized by __
mucinous cystadenoma
| tall columnar epithelium and mucin containing cytoplasm
102
3 indications for MRI screening of breast cancer
>20% lifetime risk (genetically predisposed, history of mantle radiation for Hodgkins)
screen of contralateral breast in breast cancer
screen pts with breast implants
103
What is in cryoprecipitate
fibrinogen, factor XIII, von willebrand factor
104
What blood transfusion product has the most fibrinogen?
cryoprecipitate
105
follow up for microinvasive cervical cancer with negative margins on LEEP
repeat Pap in 3-6 months for 2 years, then twice per year for 5 years
106
Lymph node metastasis in endometrial cancer occurs in __% of well staged cases
10%
107
chemo choice for uterine carcinosarcoma
carboplatin and paclitaxol
108
optimal debulking in cytoreductive surgery is defined as when each visible tumor implant is < __
1 cm
109
treatment of adenocarcinoma in situ of cervix
cone is sufficient if margins are not involved
110
What tumor is characterized by absence of chorionic villi withh proliferation of intermediate trophoblasts
placental site trophoblastic tumor
111
What tumor is characterized by neoplastic syncytiotrophoblast and cytotrophoblast without chorionic villi?
choriocarcinoma
112
Complete mole has __% risk of persistence after evacuation
15%
113
treatment for ductal carcinoma in situ with negative margins
radiation
114
treatment for ductal carcinoma in situ in older patients with comorbidities
lumpectomy alone, or with tamoxifen (not radiation)
115
treatment for multifocal DCIS
simple mastectomy
116
treatment for incisional hernia >4cm
mesh
117
treatment for incisional hernia 1cm at port site
primary closure
118
treatment for incisional hernia 2x2 cm at umbilicus
primary closure
119
treatment for incisional hernia >8cm discovered incidentally
nothing, low risk for incarceration, high risk of recurrence
120
Risk of having an inherited predisposition to breast ca and ovarian ca: personal history of breast cancer
and ovarian cancer
>20%
121
Risk of having an inherited predisposition to breast ca and ovarian ca: Women with ovarian cancer and a close
relative with ovarian cancer, premenopausal
breast cancer, or both
>20%
122
Risk of having an inherited predisposition to breast ca and ovarian ca: Women with ovarian cancer who are of
Ashkenazi Jewish ancestry
>20%
123
Risk of having an inherited predisposition to breast ca and ovarian ca: Women with breast cancer at 50 years or younger and a close relative with ovarian
cancer or male breast cancer at any age
>20%
124
Risk of having an inherited predisposition to breast ca and ovarian ca: Women of Ashkenazi Jewish ancestry in whom breast cancer was diagnosed at age 40 years
or younger
>20%
125
Risk of having an inherited predisposition to breast ca and ovarian ca: Women with a close relative with a known BRCA1 or BRCA2 mutation
>20%
126
Risk of having an inherited predisposition to breast ca and ovarian ca: Women with breast cancer at age 40 years or younger
5–10%
127
Risk of having an inherited predisposition to breast ca and ovarian ca: Women with ovarian cancer, primary peritoneal cancer, or fallopian tube cancer of high grade, serous histology at any age
5–10%
128
Risk of having an inherited predisposition to breast ca and ovarian ca: Women with bilateral breast cancer (particu- larly if the first case of breast cancer was diag- nosed at age 50 years or younger)
5–10%
129
Risk of having an inherited predisposition to breast ca and ovarian ca: Women with breast cancer at age 50 years or younger and a close relative with breast cancer at age 50 years or younger
5–10%
130
Risk of having an inherited predisposition to breast ca and ovarian ca: Women of Ashkenazi Jewish ancestry with breast cancer at age 50 years or younger
5–10%
131
Risk of having an inherited predisposition to breast ca and ovarian ca: Women with breast cancer at any age and two or more close relatives† with breast cancer
at any age (particularly if at least one case of breast cancer was diagnosed at age 50 years or younger)
5–10%
132
neurologic symptoms of cerebellar degeneration, ovarian mass, normal head MRI
paraneoplastic syndrome - Anti-Y o progressive cerebellar degeneration - causes direct toxicity to Purkinje cells,
133
heart sound in gas embolism
mill- wheel murmur
134
treatment of gas embolism in lsc surgery
Release of the pneumoperitoneum
steeper Trendelenburg position
turned to the left side (Durant position) to further prevent flow of the gas into the pulmonary circulation
135
What should you do when you get Pap with atypical glandular cells?
Colpo with endocervical sampling
136
Historically, __ has been considered one of the most active (chemo) regimens in the treatment of carcinosarcoma.
ifosfamide–cisplatin
137
Surgery confirms that she has gelatinous ascites and bilateral ovarian masses. Final pathology identifies pseudomyxoma peritonei. The most likely primary site is the
appendix
138
Primary tumor? ytokeratin 7 (KRT7 or CK7), PAX8, and WT1
ovarian
139
Primary tumor? cytokeratin 20 (KRT20 or CK20),
| CEA, and CDX2
gastrointestinal
140
grade 1 immature teratoma in her left ovary; management after surgery?
surveillance (patients with stage IA grade 1 immature teratoma have 5-year survival rates higher than 90% with no clear evidence to suggest that additional chemotherapy improves the outcome)
141
s/p myomectomy pathology report characterizes the problem as “smooth muscle tumor of uncertain malignant potential.” The next best step in her management is
surveillance
142
2 meds for prevention of chemotherapy-associated emesis
dexamethasone, selective type three 5-hydroxytryptamine (5-HT3) receptor antagonist (ondansetron)
143
Final pathology shows a stage IA grade 1 endometrioid adenocarcinoma. Recommended 3–6 months follow-up surveillance is
pelvic examination; 85% of recurrent disease occurs at the vaginal cuff and most women present with vaginal bleeding
144
treatment for cervical cancer, stage IA2 lesion
modified radical hysterectomy with concomitant pelvic lymph node dissection
145
cervical cancer Stage IA1
tumor with stromal invasion, less than a 7-mm horizontal spread, and less than 3 mm in depth
146
cervical cancer Stage IA2
tumor with stromal invasion, less than a 7-mm horizontal spread, and 3–5 mm in depth
147
cervical cancer Stage IB1
a grossly visible tumor confined to the cervix and less than 4 cm or a microscopic lesion with dimensions greater than a stage IA tumor
148
official CA 125 level that meets criteria for Gyn Onc referral for premenopausal
200
149
management of 60yo, EMB with complex atypical hyperplasia
hysterectomy plus bilateral salpingo-oophorectomy
150
A 31-year-old woman comes to your office with a 9-cm right ovarian mass. Surgical resection with laparoscopic oophorectomy is performed. The final pathologic findings show a granulosa cell tumor confined to the ovary without surface involvement. Pelvic washings are negative for malignant cells. The best next step in management is
endometrial sampling; Endometrial hyperplasia is observed in approximately 25–50% of patients with granulosa cell tumors of the ovary.
151
name 4 Sex cord–stromal tumors
granulosa cell tumors
fibromas
thecomas
Sertoli–Leydig cell tumors
152
the likelihood of developing a subsequent primary peritoneal carcinoma in patients with a BRCA mutation
4.5%
153
The lesion associated with a p53 mutation that is found incidentally in salpingectomy specimens is
Serous tubal intraepithelial carcinomas
154
precursor lesion in the distal fallopian tube that can lead to extra-uterine (pelvic) high-grade serous carcinomas
STIC (Serous tubal intraepithelial carcinomas)
155
A woman with a BRCA2 mutation is scheduled to undergo a risk reducing bilateral salpingoophorectomy. To maximize the reduction of this patient’s risk of ovarian cancer, the procedure should include
Ligation of the ovarian vessels 2cm proximal to identifiable ovarian tissue
156
In evaluating fallopian tubes for carcinoma in women undergoing risk-reducing surgery, what is the most important portion of the fallopian tube to be evaluated?
Fimbriae
157
Example of HER2-directed treatment
Trastuzumab
158
A 37-year-old gravida 2 para 2 is diagnosed with triple-negative breast cancer with a tumor size of 1.5cm and positive lymph nodes. Adjuvant chemotherapy is recommended, and the potential side effects are reviewed. The chemotherapy agent which carries the highest risk for ovarian toxicity is
cyclophosphamide
159
A patient returns for follow up one year after her initial diagnosis of early breast cancer treated with Tamoxifen. She reports vasomotor symptoms and is interested in non-pharmacological options. The next best step in the management of this patient’s symptoms is
Relaxation therapy
160
treatment for febrile neutropenia in low risk pt
outpatient for low risk; ciprofloxacin and amoxicillin–clavulanic acid
161
Endometrial biopsy reveals a uterine papillary serous carcinoma. In contrast to endometrioid adenocarcinoma of the endometrium, the factor with which uterine papillary serous carcinoma is associated is
TP53 mutations
162
What type of pathology does Type I endometrial cancer include?
endometrioid endometrial cancer
163
What type of pathology does Type II endometrial cancer include?
poorly differentiated endometrioid adenocarcinomas
clear cell types
serous cell types
164
Type I or Type II endometrial cancer? younger patients
type I
165
Type I or Type II endometrial cancer? associated with obesity, hyperlipidemia, and hyperestrogenism
type I
166
Type I or Type II endometrial cancer? ER/PR positive
type I
167
Type I or Type II endometrial cancer? 90% with TP53 mutations
type II
168
Type I or Type II endometrial cancer? 80% PTEN mutation
type I
169
Type I or Type II endometrial cancer? more likely to present with metastatic disease at original diagnosis
type II
170
A 54-year-old woman with breast cancer has completed 5 years of chemotherapy with tamoxifen citrate. Her medical oncologist has suggested that she use an aromatase inhibitor (AI) instead. The most likely adverse effect that she will experience if she makes the switch from tamoxifen to an AI is
joint aches
171
In patients with advanced ovarian cancer that has been suboptimally cytoreduced, the current standard treatment is adjuvant __ after surgery
IV carboplatin and paclitaxel
172
The outcome associated with preoperative mechanical bowel preparation is
trick questions, no improvement
173
The criteria for a vaginal radical trachelectomy and pelvic lymphadenectomy for cervical cancer (5)
* Desire for fertility
* Reproductive age, typically younger than 40 years
* Lesion size 2 cm or less with no extension to upper endocervix
* Stage IA with lymphovascular invasion, stage IA2, or stage IB1
* No evidence of nodal metastasis
174
The three most common malignant germ cell tumors
dysgerminoma
endodermal sinus tumor
immature teratoma
175
treatment for placental-site trophoblastic tumor
total hysterectomy; 10% of such tumors extend into the cervix and 50% are invasive into the outer one third of the myometrium
176
CREOG def of severe C diff
WBC >15, Cr >1.5 times baseline
177
CREOG treatment for mild/moderate C diff
PO flagyl
178
CREOG treatment for severe C diff
PO vancomycin
179
PE, patient develops HIT, what anticoagulation should you switch to?
argatroban (direct thrombin inhibitor) [similar to bivalirudin]
180
The current standard of care for stage II–IV LGSC (low-grade serous ovarian cancer) is
surgical cytoreduction followed by platinum– taxane-based chemotherapy
181
Compared with serous carcinoma of the ovary, the factor with which clear cell carcinoma of the ovary is more commonly associated is
endometriosis
182
next step for 25yo with CIN 2
observation with repeat colposcopy and cytology at 6-month intervals for 12 months
183
A 57-year-old woman is treated with cisplatin-based chemoradiotherapy for stage IIB cervical adenocarcinoma. Thirteen months after completion of radiotherapy, she has a central pelvic recurrence and undergoes total pelvic exenteration. Final pathology shows two positive pelvic lymph nodes, negative surgical margins, and a poorly differentiated adenocarcinoma. The prognostic factor that most consistently predicts poor outcome in this patient is
time to recurrence
184
A 73-year-old woman comes to your office with a prolonged history of vulvar pruritus and burning. On examination, the vulva and perineum have a red, velvety, inflamed appearance. An office biopsy is performed, revealing large cells with prominent nuclei and coarse chromatin. Diagnosis?
extramammary Paget disease
| do Cervical cancer screening, colonoscopy, and mammography to looking for coexisting malignancies
185
After comprehensive surgical staging, a 65-year-old woman is diagnosed with stage IB uterine papillary serous carcinoma. The next step in management is
carboplatin–paclitaxel
186
A 35-year-old woman palpates a 1-cm solid breast mass. A needle biopsy is carried out and con- firms an invasive ductal carcinoma. The best treatment for this patient is
lumpectomy with sentinel lymph node biopsy
187
Cervical cancer: concurrent chemotherapy and radiation therapy should be used for: (3)
* early-stage disease and bulky cervical tumors (greater than 4 cm)
* high-risk factors after radical surgery, such as posi- tive lymph nodes and margins as well as parametrial extension
* stage IIB–IVA locally advanced cervical cancer
188
A 49-year-old woman undergoes a radical hysterectomy, BSO and bilateral pelvic lymph node dissection for stage IB1 cervical cancer. Final pathology shows a small cell carcinoma of the cervix. All resection margins and lymph nodes are negative for tumor. The next step in management is
chemotherapy
189
The U.S. Public Health Service-preferred regimen for postexposure prophylaxis for occupational exposures to HIV
emtricitabine, tenofovir, raltegravir
190
Complete mole, now s/p D&C. In terms of contraception, the most appropriate, evidence-based treatment recommendation for the next 6 months is
oral contraceptives
191
Only variable in GOG 172 with correlation w IP catheter complication
left colon–rectosigmoid resection
192
Treatment for DCIS in patient who doesn't want surgery
radiation therapy
193
A 50-year-old woman is taken to the operating room for laparoscopic management of a 5-cm complex right adnexal mass. Pelvic washings are collected before beginning the procedure and a laparoscopic RSO is performed. During the dissection of the broad ligament, the ovary is ruptured with leakage of a small amount of clear fluid. The frozen section returns as high-grade papillary serous carcinoma grade 3; the remainder of the staging surgery is then performed. The final pathologic report shows that all surgical specimens, including the pelvic washings, are negative. In regard to use of chemotherapy or radiation therapy, the most appropriate management is
intravenous chemotherapy because of the high-grade histology
194
the strongest scientific evidence for the benefit of acupuncture in cancer patients is for
emesis
195
A 27-year-old woman, gravida 1, para 0, with an intrauterine pregnancy at 12 weeks of gestation comes to your office for routine prenatal evaluation. Cervical cytologic screening reveals a low- grade squamous intraepithelial lesion. Colposcopy indicates cervical intraepithelial neoplasia 1 (CIN 1). The most appropriate next step in management is
reassessment postpartum
196
A 54-year-old woman comes to your office with increasing pelvic pain. On examination, she has a small uterus, a small right ovary, and a left ovary that is enlarged to 6 cm and is mobile. Pelvic ultrasonography confirms a 6-cm complex adnexal mass. Her CA 125 level is 45 international units/mL. The patient undergoes a laparoscopic left salpingo-oophorectomy and pelvic washings, and the frozen section reveals a grade 2 serous adenocarcinoma of the ovary. The remainder of the abdomen and pelvis are normal. The most appropriate immediate management for this patient is
hysterectomy, contralateral salpingo-oophorectomy, omentectomy, lymphadenectomy, peritoneal washings, peritoneal biopsies
197
What is most beneficial in decreasing risk of postoperative ileus
early postoperative feeding
198
A 31-year-old woman comes to your office with vaginal bleeding. On examination, she is found to have a friable cervical mass, extension to the pelvic sidewalls, and a palpable supraclavicular lymph node. Biopsies of the cervix and lymph node confirm the presence of squamous cell car- cinoma. A PET-CT scan is performed and reveals extensive hypermetabolic pelvic disease, para-aortic lymphadenopathy, multiple lung lesions, and a supraclavicular node. She wishes to pursue treatment. You advise her that her best management option is
chemotherapy
199
How to diagnose postmolar gestational trophoblastic disease (3 options)
* β-hCG level plateau of four values plus or minus 10% recorded over 3 weeks
* β-hCG level increase of more than 10% over three values recorded over 2 weeks
* persistence of detectable β-hCG levels more than 6 months after evacuation
200
The adverse effect of tamoxifen that she is most likely to experience is
hot flushes
201
A 27-year-old nulligravid woman had a screening Pap test which showed atypical glandular cells. Follow-up colposcopy and biopsies with endocervical curettage indicated at least adenocarcinoma in situ. Final pathology from a cold conization showed an invasive adenocarcinoma with a diameter of 5 mm and depth of invasion of 2 mm, negative margins, and no lymphovascular space invasion. The best next step in management is
stage IA1. routine cervical cancer surveillance examinations (young age. otherwise simple extrafascial hysterectomy)
202
A 9-year-old girl has a complex adnexal mass and precocious puberty. The tumor marker most likely to assist in your preoperative evaluation is
inhibin B level
| common presentation for a juvenile-type granulosa cell tumor
203
most likely trophoblastic disease subtype: Risk of persistence after dilation and evacuation is approximately 20%
Complete mole
204
most likely trophoblastic disease subtype: Fetal vessels often are seen on hematoxylin and eosin stain
Partial mole
205
most likely trophoblastic disease subtype: Systemic metastases occur frequently
Gestational choriocarcinoma
206
most likely trophoblastic disease subtype: Histology characterized by proliferation of intermediate trophoblastic cells
Placental-site trophoblastic tumor
207
What hemostatic agent? Acidic plant-based extract that saturates with blood at the bleeding site and forms a brownish or black gelatinous mass, which aids in the formation of a clot via the intrinsic coagulation pathway
oxidized regenerated cellulose (Surgicel)
208
What hemostatic agent? Purified bovine-based agent that attracts platelets to a bleeding site, initiating the formation of a physiologic platelet plug
microfibrillar collagen
209
What hemostatic agent? Bovine- or human-extracted agent that converts fibrinogen to fibrin in addition to cross- linked granules that aid in platelet adhesion and aggregation
flowable gelatin matrix with thrombin (Gelfoam)
